Re: [pct-l] suture kits

["ROBERT E RIESS" <CDRRIESS@prodigy.net>]

Once upon a time in a galaxy far far away, I was the Chief Staff Officer on
a Destroyer Squadron, deployed to the western Pacific.  Since I was a
Commander and the squadron corpsman was a Chief Petty Officer, I was able to
talk him into giving me a supply of sutures, 4.0 silk if I recall.  I had
taken quite a bit of first aide and emergency (survival, really) medicine,
and the Chief gave me some refresher training on suturing.  All USN
independent duty corpsmen know how to put in sutures.   After 10 years, I
have used 2 sutures, both to sew up a gash in my Golden Retriever's face.
Dog fight.

Couple of things I recall from the old Doc.  (All Navy corpsmen are
nicknamed Doc.)  First, getting stitches hurts like hell.  The rule of thumb
is the suture should be TWICE as deep as it is long.  Second, you use a
separate suture for each stitch.  A 2-inch gash might take 8 sutures to
close properly.  Third, almost anybody could probably do an acceptable job
suturing a superficial wound in somebody else.  Suturing youself is an
entirely different kettle of fish.  Less than half your body is accessable.
Fourth, sutures carried for a few days in a backpack are not likely to
remain sterile because the foil wrappers are pretty fragile.  The Doc
carried his in a Tupperware sandwich tub, in a backpack.

There were a couple of Doc's pearls of wisdom I found most helpful.  A
non-medical person should only attempt to suture a superficial wound,
basically a skin cut.  If it's life and death, you do what you have to do.
You can fashion an acceptable suture kit from a small curved upholstery
needle and a spool of fine dental floss.  Personally, I prefer black nylon
button thread because you can see it better when applying and removing
sutures.  Of course, your needle and thread will NOT be sterile, so
appropriate precautions should be taken.  There's a vote for alcohol stoves
in here somewhere.

In order to stick and hold, butterfly bandages need a really clean, dry
surface.  Medics use betadine solution as much for the stick as for the
antiseptic.  A good stabilizing cloth bandage has to go on over the
butterflies.

Now here's a sea story for any who may be interested.  In 1987 I was the XO
on a guided missile frigate deployed to the Persian Gulf.  We were operating
outside the Straights of Hormuz, at leat several hours by helicopter from
any support facility.  About 0200 (2am) one of our sailors took a bad fall
and gashed the back of his head on a steel clete.  Luckily, somebody was
with him and the corpsman was called.  In less than 2 minutes, the corpsman
was on the scene, and the man had lost about 2 pints of blood.  There was a
30 inch puddle of blood on deck.  His wound was only 7 cm long, but it had
severed one of those tiny little arteries just below the skin in the back of
the head.  Our corpsman saved that man's life that night by reconnecting a
severed artery no bigger than this  >>>>>   O .  (1/8 inch)  He put in 4 of
the tiniest sutures you can imagine.  20 hours later a vascular surgeon in a
Naval Hospital looked at the wound through a microscope and left it just as
it was.  I recall all this because I wrote the citation for the Doc's medal,
which turned out to be the Legion of Merit.  True story.  Every word.

Hike on!!  Bob Riess at the TrailHead in San Diego.

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